Ocular Syphilis—Back Again: Understanding Recent Increases in the Incidence of Ocular Syphilitic Disease

Abstract

Syphilis has reemerged in developed countries. This may be related to the post-AID S/HAART era, with a growing pool of HIV-positive men who oftenly practice unsafe sex. We underscore the importance of a high index of suspicion of ocular syphilis in patients with these characteristics.

Posterior syphilitic uveitis: clinical characteristics, co-infection with HIV, response to treatment

“…All patients in this series were men, which is in agreement with other series on ocular syphilis demonstrating a predominance of men [4,6,11,[15][16][17]. Although an early report [20] suggests an increase in the number of cases of syphilis among women, most series on ocular syphilis, including ours, have not reflected this change.…”

“…This is likely due to a progressive decline in AIDSrelated mortality, as other series [4,5,14] studied patients seen earlier (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996) than the current series. In contrast, Fonollosa et al [6] observed a 75% co-infection rate among 12 patients seen between 2005 and 2007, all of whom had iritis and vitritis. The high rate of HIV coinfection observed in our series underscores the importance of HIV testing in patients presenting with ocular syphilis.…”

“…Several authors have published series on ocular syphilis [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Most studies include patients with anterior and posterior uveitis, and few look at posterior uveitis specifically [4,5,14].…”

“…We compared the clinical characteristics of our patients with those of other large series on posterior syphilitic uveitis [4,6,14]. It is often difficult to compare the prevalence of clinical findings among series because of the different ways in which results are presented.…”

“…A strong association between HIV and ocular syphilis has been reported [5][6][7][8]. The highly active antiretroviral therapy (HAART) era has seen an increase in the number of cases of ocular syphilis [9,10], which may be due to a decrease in AIDS-associated mortality [6].…”